Nondisseminated rhinosporidiosis with multisite involvement in the head and neck.

Rhinosporidiosis is a communicable disease prevalent in tropical countries that affects one or more mucocutaneous sites such as the nasal cavity, pharynx, skin, bronchus, genitals, and bone, in isolation or together. We report a case of multicentric rhinosporidiosis involving the nasal cavity, oropharynx, larynx, and cheek skin without disseminated disease outside the head and neck. Although the appearance of mucocutaneous lesions in our patient was similar to that of papilloma or neoplasm, the distinct clinicopathologic characteristics of the rhinosporidiosis guided us in managing the case successfully. In our own experience with 11 patients with rhinosporidiosis on whom we operated over the past 5 years, the nasal cavity and pharynx were the most commonly involved sites in the head and neck. Surgical excision of all lesions along with cauterization of the base and long-term dapsone therapy is the current standard of care for multicentric rhinosporidiosis.

Dermatoscopic signs in cutaneous leishmaniasis

Abstract: Dermoscopy is a non-invasive technique widely used to aid in the characterization and diagnosis of pigmented skin lesions. Recently, it has also been employed for the evaluation of non-pigmented skin tumours, and inflammatory and infectious cutaneous diseases. Although the diagnosis of cutaneous leishmaniasis is confirmed by the demonstration of amastigotes in infected skin or by the growth of promastigotes in culture medium, dermoscopy could be useful as a further diagnostic test. We report a patient with a nodular lesion located on the right cheek for almost two years. The lesion was clinically suggestive of cutaneous leishmaniasis. Dermoscopy showed yellow tears, erythema and vascular structures. The diagnosis was confirmed by the demonstration of amastigotes in a skin scraping sample.

The effect of skin moisture, pH, and temperature on the density of Demodex folliculorum and Demodex brevis (Acari: Demodicidae) in students and staff of the Erzincan University, Turkey.

BACKGROUND: The aim of this study was to determine the prevalence and density of Demodex folliculorum and Demodex brevis in students and staff of the Erzincan University, Turkey, and to define the influence of age, gender, educational level, and hygiene as well as skin moisture, pH, and temperature on the presence of Demodex mites. METHODS: Healthy people without apparent facial dermatoses from nine faculties and five vocational schools of the university were included in the study. The measurements for moisture, pH, and temperature were conducted in the cheek region, while samples for mite presence were taken from the same region using the standard superficial skin biopsy technique. RESULTS: A total of 538 healthy people, 385 students and 153 university staff, were included in the study. Demodex mites were detected in 50.1% of the students (mean 7.1/cm2 ) and in 69.3% of the university staff (mean 13.1/cm2 ). There were statistical differences between the groups of people who were cleaning their face one, two, three, or more times daily and between those who were using and not using personal towels. There was a borderline significant difference between the different age groups and people with different education levels. The density of mites was higher in those with a skin moisture of less than 50%, with a pH of 5-6.5 and temperature of 24-28 °C, however the differences between the groups with different skin moisture, skin pH, and skin temperature were not statistically significant. CONCLUSION: Demodex mites are very prevalent in healthy individuals of both sexes, and this should be taken into consideration when epidemiological and clinical studies are conducted with patients having different dermatological ailments.

Dermatoscopic signs in cutaneous leishmaniasis.

Dermoscopy is a non-invasive technique widely used to aid in the characterization and diagnosis of pigmented skin lesions. Recently, it has also been employed for the evaluation of non-pigmented skin tumours, and inflammatory and infectious cutaneous diseases. Although the diagnosis of cutaneous leishmaniasis is confirmed by the demonstration of amastigotes in infected skin or by the growth of promastigotes in culture medium, dermoscopy could be useful as a further diagnostic test. We report a patient with a nodular lesion located on the right cheek for almost two years. The lesion was clinically suggestive of cutaneous leishmaniasis. Dermoscopy showed yellow tears, erythema and vascular structures. The diagnosis was confirmed by the demonstration of amastigotes in a skin scraping sample.

Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection.

Free-living amebae are ubiquitous in our environment, but rarely cause cutaneous infection. Balamuthia mandrillaris has a predilection for infecting skin of the central face. Infection may be restricted to the skin or associated with life-threatening central nervous system (CNS) involvement. We report a case of a 91-year-old woman, who presented with a non-healing red plaque over her right cheek. Several punch biopsies exhibited non-specific granulomatous inflammation without demonstrable fungi or mycobacteria in histochemical stains. She was treated empirically for granulomatous rosacea, but the lesion continued to progress. A larger incisional biopsy was performed in which amebae were observed in hematoxylin-eosin stained sections. These were retrospectively apparent in the prior punch biopsy specimens. Immunohistochemistry and polymerase chain reaction studies identified the organisms as Balamuthia mandrillaris. Cutaneous infection by B. mandrillaris is a rare condition that is sometimes complicated by life-threatening CNS involvement and which often evades timely diagnosis due to its rarity and nonspecific clinical manifestations. Moreover, these amebae are easily overlooked in histopathologic sections because of their small number and their resemblance to histiocytes. Dermatopathologists should be familiar with the histopathologic appearance of these organisms and include balamuthiasis and other amebic infections in the differential diagnosis of granulomatous dermatitis.

Demodex Mite, Rosacea and Skin Melanoma; Coincidence or Association?

OBJECTIVE: To examine the possible associations between Demodex folliculorum and a number of skin diseases. METHODS: Standardized skin surface biopsy samples were obtained from the cheeks of 144 patients with histopathologically proven basal cell carcinoma (BCC, n = 27), squamous cell carcinoma (SCC, n = 28), melanoma (n = 23), discoid lupus erythematosus (DLE, n = 32), and rosacea (n = 34). Thirty-four sex- and age-matched healthy volunteers served as controls. Mite density (per cm2) and infestation (density ≥ 5) were compared between the controls and patients. RESULTS: Mite infestation rates (%) did not differ significantly between the controls (20.6) and patients with BCC (22.2, p = 0.88), SCC (17.9, p = 0.79), melanoma (4.3, p = 0.08), and DLE (21.9, p = 0.90). Compared with the controls, the mite infestation rate was significantly higher in patients with rosacea (47.1, p = 0.02, odds ratio: 3.43, 95% confidence interval: 1.18-9.99). The mean mite density did not differ significantly between the controls (4.11 ± 2.17) and patients with BCC (5.34 ± 2.35, p = 0.75), SCC (3.57 ± 2.01, p = 0.38), and DLE (3.56 ± 1.34, p = 0.83), whereas it was significantly higher in patients with rosacea (8.78 ± 3.58, p = 0.02) and lower in patients with melanoma (1.89 ± 0.69, p = 0.02). CONCLUSIONS: D. folliculorum may be associated with rosacea and melanoma but not with BCC, SCC, or DLE.

Actinomycosis of the cheek.

INTRODUCTION: Actinomycosis is an uncommon chronic granulomatous infection first described by Bollinger in 1 877.The infection is caused by actinomyces species and it is characterized by slow contiguous spread and suppurative inflammation, formation of multiple abscesses and sinus tracts with possible drainage of "sulfur granules". CASE OUTLINE: We report an unusual case of actinomycosis of the cheek that occurred 6 years after buccal odontogenic abscess. A 56-year-old male was referred to the Department of Oral Surgery because of a painless swelling of the left cheek, which initiated three weeks prior to the referral. The diagnosis of actinomycosis was confirmed by histopathologic examination. In accordance with the diagnosis oral penicillin was prescribed for four months with complete resolution. CONCLUSION: This case of actinomycosis is presented as a rarity. For proper diagnosis, careful examination and a high degree of clinical suspicion are necessary.

Masseter muscle cysticercosis: a common disease with uncommon presentation.

Cysticercosis in humans is caused by Taenia solium larvae infestation. Oral cysticercosis is a rare condition and is challenging to diagnose. We present a case of masseter cysticercosis in a young woman who presented with painful recurrent cheek swelling. Diagnosis confirmed it after neuroimaging and histopathological examination of the excised lesion from masseter muscle.

Egg viability studies on Clinostomum complanatum (Digenea: Clinostomidae) from two experimental animal model systems.

Viability of eggs is important for the successful completion of trematode life cycle, both in natural and laboratory conditions. The present study was designed to check the viability of eggs released by the digenetic trematode parasite Clinostomum complanatum transformed in experimentally infected chicken and rabbit eye. The incubation of the released eggs in distilled water at 28 ± 1 °C led to the embryonation followed by hatching on tenth day to release miracidia. These can be used to infect the snails. We propose that these two in vivo model systems can be used as a source of viable eggs for further studies on developmental biology and life cycle where in law-protected animals are not to be used. To the best of our knowledge, in contrast to the previous attempts, this is the first successful study to report any experimental model to produce ovigerous adult worms capable of releasing viable eggs.

Primary oral myiasis due to Chrysomya bezziana treated with Ivermectin. A case report.

Primary oral myiasis due to Chrysomya bezziana is a rare condition caused by invasion of tissues by larvae of the flies. A case of Oral myiasis is presented in a 12 year old boy with neuro-degenerative disease with seizures. Intra orally, a soft tissue pocket in the left buccal mucosa and a pocket under the palatal mucosa was seen containing maggots. Extra orally indurated erythematous swelling was present near the commissure of the mouth. Predisposing factors identified in the present case were mouth breathing, incompetent lips, low socioeconomic condition, malnutrition, and inability of the child to perform daily activities due to his neurodegenerative disease. Treatment consisted of manual removal of maggots following irrigation and application of turpentine oil along with a single dose Ivermectin 3 mg that was given systemically. Complete healing of the lesion was observed within 10 days without any recurrence for a follow up period of 1 year Medical personnel taking care of old / debilitated / unconscious patients need to bear in mind the possibility of Chrysomya bezziana infestation in them.

Acquired toxoplasmosis of the buccal area with extranodular involvement: report of an unusual case.

Acquired toxoplasmosis is a common parasitic infection in humans. It can be caused by ingestion of infected meat or other food that has been contaminated by the feces of infected cats. Approximately 90% of immunocompetent patients with acquired toxoplasmosis are asymptomatic and undiagnosed; in the other 10%, toxoplasmosis manifests as a nonspecific, self-limited illness that usually does not require treatment. In symptomatic cases, cervical lymphadenopathy is one of the most common clinical findings. We report the case of a 33-year-old woman who experienced unilateral facial swelling secondary to toxoplasmosis. In addition to the atypical location of her disease (i.e., the buccal area), the atypical histopathologic findings in this case (e.g., extranodular involvement) constituted a very unusual presentation of toxoplasmosis.

Fibrous subcutaneous nodule caused by Dirofilaria repens.

A case is described of subcutaneous dirofilariasis in a Greek woman who had visited many countries around the world, including areas of sub-Saharan Africa. The patient presented with a single hard subcutaneous nodule on the right cheek, with no cutaneous manifestations of early or long-standing onchocercal dermatitis or eye lesions. The nodule was removed surgically and the filarial adult worm Onchocerca volvulus was initially diagnosed, based on the history, the hardness and large size of the fibrous nodule and the absence of cuticular longitudinal ridges of the parasite in the initial histological sections. Bloodless skin snips taken from the regions of the scapula, iliac crest and lateral calf were negative for O. volvulus microfilariae. Serial cross-sections of the fibrous nodule and gross examination of a portion of the adult worm removed from the nodule revealed the characteristic longitudinal ridges which allowed the identification of the worm as Dirofilaria repens. The aim of this report on tropical and non-tropical filarial worms affecting the skin and eyes is to point out the key features for precise identification of the parasites and differential diagnosis of the infections caused by the filiform nematode worms of O. volvulus, and Dirofilaria species.

The prevalence of Demodex folliculorum on the scrotum and male perineal skin.

Demodex folliculorum (D. folliculorum) is a human ectoparasite that resides in the pilosebasceous skin unit. Common sites of predilection are the skin of cheeks, forehead, nose, nasolabial fold and eyelids. Genital D. folliculorum inoculation case reports are extremely rare and depend on investigation of skin lesions. There is no study of genital skin without lesions, and, as far as we know, there is no literature on D. folliculorum prevalence in male genital skin. We examined D. folliculorum prevalence on the healthy scrotum and male perineum. One hundred males were examined for D. folliculorum on facial and genital skin. Samples were taken from cheek, forehead, scrotum and perineum by standard skin surface biopsy (SSSB) or hair epilation. The mean age was 53.5+/-13.0 (24-70) years. Eight percent of males had D. folliculorum on their facial skin. Mean Demodex density (Dd) of men with D. folliculorum positivity was 5.1+/- 2.9/ cm (2)(2-9/cm(2)). Diagnostic results of both sampling methods were similar. No D. folliculorum was demonstrated on genital skin.

A sticktight flea removed from the cheek of a two-year-old boy from Los Angeles.

Species-level identification of an ectoparasite often requires outside expertise. Patients are increasingly turning to the internet for medical information, in part to gain access to experts. We present a case of a flea identified after contact was made between a patient's father and the authors via an insect-related forum on the internet. The flea had been attached for 12 hours without inducing symptoms before it was removed. The specimen was identified as a sticktight flea Ectoparasites in the differential diagnosis for this case are discussed.

Polystomoides magdalenensis n. sp. (Monogenoidea: Polystomatidae), a parasite of buccal cavity of Trachemys callirostris callirostris (Testudinata: Emydidae) from Colombia.

Polystomoides magdalenensis n. sp. is described from the buccal cavity of the Colombian slider Trachemys callirostris callirostris (Gray, 1856) in the middle of Magdalena River drainage, Colombia. The new species is characterized by a combination of traits, i.e., 29-35 genital spines, outer and inner hamuli length (123-150 and 54-63, respectively), testis size (261.4-554.5 x 388.2-768.4), marginal hook lengths (45-51), and pharynx length (150-333), as well as testis length/oral sucker length, testis length/pharynx length, and testis width/pharynx width ratios. This is the first species described from turtles in Colombia and the fifth reported in chelonians from South America.

Effect of isopod parasite, Cymothoa indica on gobiid fish, Oxyurichthys microlepis from Parangipettai coastal waters (South-east coast of India).

The present study reported for the first time on the effect of isopod parasite, Cymothoa indica infestation on Oxyurichthys microlepis an ecologically important gobiid fish from Parangipettai coastal environment (South-east coast of India). The loss of weight in host fishes (male 20.47 and female 32.84%) were observed due to parasitism. The weight of uninfested female fish was found to be higher than that of infested one. The calus like thickening developed on the gill arch and gill filaments of host fish due to the persistent irritation caused by the appendages of the parasite. The reduction of gill surface area was observed due to the attachment of the parasites. The maximum reduction noticed in the first gill arch is mainly due to the heavy pressure exerted by the parasite. Details of gross lesions observed in the branchial chamber, buccal cavity and body surface was enumerated. Heavy infestations of parasitic juveniles have the potential to kill small fingerlings. The swimming capacity of the fish was also found to be affected.

[The incidence of Demodex folliculorum in patients with chronic kidney deficiency]. / Kronik böbrek yetmezligi olan hastalarda Demodex folliculorum görülme sikligi.

The aim of this study was to evaluate the prevalence of Demodex folliculorum in immune suppressed patients. The present study was carried out on individuals being treated for chronic kidney deficiency and immune suppressed patients that were hospitalized in the Hemodialysis Units and Internal Disease Service of the Cumhuriyet University Hospital. Forty-seven patients with chronic kidney deficiency (CKD) and a control group of thirty-eight healthy and actively exercising individuals were included in this investigation. By means of a questionnaire given to the patients and control group, complaints of allergenic related dermal and optical disorders were detected and the prevalence of Demodex was also evaluated by this questionnaire. First, the presence of D. folliculorum was proven taking dermal specimens from the cheek of every individual. Afterwards, at least two eyelash specimens from the lower and upper eyelid-eyelash follicles of the right and left eyes were taken and examined in a drop of olive oil between slide and cover glass microscopically. The frequency of parasites in every preparation was also determined in each positive case. D. folliculorum was found in the eyelid-eyelash follicles of 6 (12.76 %) and 12 (25.53 %) of the dermal face specimens of the 47 chronic kidney deficiency patients. On the other hand, D. folliculorum was found in the eyes of 2 (5.26 %) persons and in the dermal face specimens of 7 (18.42 %) out of a total of 38 persons in the control group. In the present study, the difference in the Demodex prevalence and complaints of dermal disorder in the two groups was found to be insignificant. In the study group, the difference was insignificant as to dermal complaints and Demodex prevalence (p < 0.05), but considerably difference was observed between complaints about eyes and Demodex prevalence (p < 0.05). Consequently, it was concluded that Demodex folliculorum may be a cause of eye disorders such as blepharitis, and this parasite can be frequently observed in persons with immune system anomalies.